颅底骨髓炎的临床特征与并发症：印度南部一家教学医院的12年研究
Clinical characteristics and complications of skull base osteomyelitis: A 12-year study in a teaching hospital in South India.
作者信息
Das Sohini, Iyadurai Ramya, Gunasekaran Karthik, Karuppusamy Reka, Mathew Zacharia, Rajadurai Ebenezer, John Ajoy O, Mani Sunithi, George Tina
机构信息
Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
出版信息
J Family Med Prim Care. 2019 Mar;8(3):834-839. doi: 10.4103/jfmpc.jfmpc_62_19.
CONTEXT
Skull base osteomyelitis (SBO) is an uncommon disease with substantial morbidity and mortality.
AIMS
The aim of this study is to characterize clinical features, outcomes, and complications of SBO. We also looked at differences in clinical profile in otogenic and non-otogenic SBO.
MATERIALS AND METHODS
This is a single-center retrospective observational study. Patients aged more than 15 years of age with clinical and radiological diagnosis of SBO admitted in general medicine department in a teaching hospital in South India from March 2006 to February 2018 were recruited.
RESULTS
A total of 41 patients with SBO were identified and included. Mean age was 56.9 ± 10.7 years. In all, 90% of patients (37/41) had diabetes mellitus and 29% (12/41) had recent head/neck surgery. Only 19% (8/41) needed ICU care, and mortality was 21% (9/41). Most common symptom was headache seen in 73% (30/41) of patients. Majority, 61% (25/41), had otogenic infections. Otogenic infections were associated with longer duration of diabetes mellitus (mean = 11.5 vs. 5 years, = 0.01), higher creatinine levels (mean = 1.66 vs. 0.9 mg/dL, = 0.014, odds ratio [OR] = 3.8), and higher incidence of cranial nerve palsy (92% vs. 56%; OR = 8.9) compared to non-otogenic SBO. Cranial nerve palsy (78%), meningitis (63%), and cerebral venous thrombosis (43%) were frequent complications of SBO in this study. The causative organisms for SBO in our cohort was bacterial in 60% (15/25) and fungal in 40% (10/25) of the patients. Surgical debridement for source control was done in 54% of patients (22/41) and was associated with survival at discharge ( = 0.001).
CONCLUSIONS
Bacterial infections are the most common cause of SBO. Otogenic SBO is associated with longer duration of diabetes mellitus and higher incidence of cranial nerve palsy. Therapeutic surgical debridement plays an important role in treatment of SBO and is associated with improved survival.
背景
颅底骨髓炎（SBO）是一种罕见疾病，具有较高的发病率和死亡率。
目的
本研究旨在描述SBO的临床特征、预后及并发症。我们还研究了耳源性和非耳源性SBO临床特征的差异。
材料与方法
这是一项单中心回顾性观察研究。纳入2006年3月至2018年2月在印度南部一家教学医院普通内科住院的年龄超过15岁、临床及影像学诊断为SBO的患者。
结果
共确定并纳入41例SBO患者。平均年龄为56.9±10.7岁。总体而言，90%（37/41）的患者患有糖尿病，29%（12/41）的患者近期有头颈部手术史。仅19%（8/41）的患者需要重症监护，死亡率为21%（9/41）。最常见的症状是头痛，见于73%（30/41）的患者。大多数患者（61%，25/41）为耳源性感染。与非耳源性SBO相比，耳源性感染与糖尿病病程较长（平均11.5年对5年，P=0.01）、肌酐水平较高（平均1.66对0.9mg/dL，P=0.014，比值比[OR]=3.8）以及脑神经麻痹发生率较高（92%对56%；OR=8.9）相关。在本研究中，脑神经麻痹（78%）、脑膜炎（63%）和脑静脉血栓形成（43%）是SBO常见的并发症。在我们的队列中，SBO的病原体60%（15/25）为细菌，40%（10/25）为真菌。54%（22/41）的患者进行了手术清创以控制感染源，且与出院时存活相关（P=0.001）。
结论
细菌感染是SBO最常见的病因。耳源性SBO与糖尿病病程较长及脑神经麻痹发生率较高相关。治疗性手术清创在SBO治疗中起重要作用，且与生存率提高相关。
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